An adult presentation of midgut volvulus secondary to intestinal malrotation: A case report and literature review.

INTRODUCTION: Midgut volvulus secondary to intestinal malrotation is a rare cause of an acute abdomen in adults, with 92 confirmed cases in the literature. Incidence of malrotation is estimated 1 in 6000 live births. 64-80% of malrotation cases present in the first month of life and 90% within the first year. Adult presentation is very rare accounting for only 0.2-0.5% of cases, of which only 15% present with midgut volvulus.

PRESENTATION OF CASE: We report a rare case of a 20 year old male with spontaneous midgut volvulus secondary to congenital malrotation of the bowel. Additionally we performed a literature review and analysis of the 92 cases of adult presentations of midgut volvulus secondary to malrotation.

DISCUSSION: Of the 92 cases, average patient age was 40 years old and a 1.7:1 male:female ratio. Diagnosis of midgut volvulus was predominantly made via CT (67%) but also by ultrasound (15%) and theatre (18%). Midgut volvulus is associated with a high risk of ischaemia and necrosis of bowel supplied by the SMA (35). 19% of cases reported required a bowel resection. The case discussed in this report required a 130 cm bowel resection which is similar to the mean bowel resection length in the literature of 121 cm. Mean associated mortality rate is 5%.

CONCLUSION: This case reinforces the importance of maintaining a high index of suspicion and closely monitoring patients presenting with non-specific abdominal pain, to allow early recognition and management of rare causes of the deteriorating surgical patient.